Heights University Hospital

All Charges

Charge

Type

Setting

Price

WALLSTENT 12/60 9FR 100cm

Facility

$5,250.00

Hospital Charge Code	270626882
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

WALLSTENT 12/90 9FR 100cm

Facility

$8,500.00

Hospital Charge Code	270627567
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

WALLSTENT 12/90 9FR 100cm

Facility

$8,500.00

Hospital Charge Code	270627567
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$2,550.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

WALLSTENT 14/40 9FR 75cm 40311

Facility

$5,148.50

Hospital Charge Code	270624967
Hospital Revenue Code	278
Min. Negotiated Rate	$772.27
Max. Negotiated Rate	$2,574.25
Rate for Payer: Aetna Commercial	$1,544.55
Rate for Payer: Aetna Medicare Advantage	$1,544.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,312.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,312.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,312.87
Rate for Payer: Cigna Commercial	$2,574.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.94
Rate for Payer: Qualcare PPO/HMO/WC	$772.27

WALLSTENT 14/40 9FR 75cm 40311

Facility

$5,148.50

Hospital Charge Code	270624967
Hospital Revenue Code	278
Min. Negotiated Rate	$772.27
Max. Negotiated Rate	$1,245.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.94
Rate for Payer: Qualcare PPO/HMO/WC	$772.27

WALLSTENT 16/40 10FR 100cm

Facility

$5,250.00

Hospital Charge Code	270627282
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

WALLSTENT 16/40 10FR 100cm

Facility

$5,250.00

Hospital Charge Code	270627282
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

WALL STENT 16X 90X 75 MM

Facility

$10,398.10

Service Code	HCPCS C1876
Hospital Charge Code	270684832
Hospital Revenue Code	278
Min. Negotiated Rate	$1,559.71
Max. Negotiated Rate	$2,516.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.71

WALL STENT 16X 90X 75 MM

Facility

$10,398.10

Service Code	HCPCS C1876
Hospital Charge Code	270684832N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,559.71
Max. Negotiated Rate	$5,199.05
Rate for Payer: Aetna Commercial	$3,119.43
Rate for Payer: Aetna Medicare Advantage	$3,119.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,651.52
Rate for Payer: Cigna Commercial	$5,199.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.71

WALL STENT 16X 90X 75 MM

Facility

$10,398.10

Service Code	HCPCS C1876
Hospital Charge Code	270684832
Hospital Revenue Code	278
Min. Negotiated Rate	$1,559.71
Max. Negotiated Rate	$5,199.05
Rate for Payer: Aetna Commercial	$3,119.43
Rate for Payer: Aetna Medicare Advantage	$3,119.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,651.52
Rate for Payer: Cigna Commercial	$5,199.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.71

WALL STENT 16X 90X 75 MM

Facility

$10,398.10

Service Code	HCPCS C1876
Hospital Charge Code	270684832N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,559.71
Max. Negotiated Rate	$2,516.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,516.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.71

WALLSTENT 20X 80X 75

Facility

$10,383.10

Service Code	HCPCS C1876
Hospital Charge Code	270684833
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.46
Max. Negotiated Rate	$2,512.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.46

WALLSTENT 20X 80X 75

Facility

$10,383.10

Service Code	HCPCS C1876
Hospital Charge Code	270684833N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.46
Max. Negotiated Rate	$5,191.55
Rate for Payer: Aetna Commercial	$3,114.93
Rate for Payer: Aetna Medicare Advantage	$3,114.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,647.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,647.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,647.69
Rate for Payer: Cigna Commercial	$5,191.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.46

WALLSTENT 20X 80X 75

Facility

$10,383.10

Service Code	HCPCS C1876
Hospital Charge Code	270684833N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.46
Max. Negotiated Rate	$2,512.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.46

WALLSTENT 20X 80X 75

Facility

$10,383.10

Service Code	HCPCS C1876
Hospital Charge Code	270684833
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.46
Max. Negotiated Rate	$5,191.55
Rate for Payer: Aetna Commercial	$3,114.93
Rate for Payer: Aetna Medicare Advantage	$3,114.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,647.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,647.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,647.69
Rate for Payer: Cigna Commercial	$5,191.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.46

WALLSTENT 22/45 11FR 100 40451

Facility

$5,773.00

Hospital Charge Code	270635129V
Hospital Revenue Code	278
Min. Negotiated Rate	$865.95
Max. Negotiated Rate	$2,886.50
Rate for Payer: Aetna Commercial	$1,731.90
Rate for Payer: Aetna Medicare Advantage	$1,731.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,472.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,472.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,154.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,472.12
Rate for Payer: Cigna Commercial	$2,886.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.07
Rate for Payer: Qualcare PPO/HMO/WC	$865.95

WALLSTENT 22/45 11FR 100 40451

Facility

$5,726.90

Hospital Charge Code	270635129
Hospital Revenue Code	278
Min. Negotiated Rate	$859.03
Max. Negotiated Rate	$1,385.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,385.91
Rate for Payer: Qualcare PPO/HMO/WC	$859.03

WALLSTENT 22/45 11FR 100 40451

Facility

$5,726.90

Hospital Charge Code	270635129
Hospital Revenue Code	278
Min. Negotiated Rate	$859.03
Max. Negotiated Rate	$2,863.45
Rate for Payer: Aetna Commercial	$1,718.07
Rate for Payer: Aetna Medicare Advantage	$1,718.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,460.36
Rate for Payer: Cigna Commercial	$2,863.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,385.91
Rate for Payer: Qualcare PPO/HMO/WC	$859.03

WALLSTENT 22/45 11FR 100 40451

Facility

$5,773.00

Hospital Charge Code	270635129V
Hospital Revenue Code	278
Min. Negotiated Rate	$865.95
Max. Negotiated Rate	$1,397.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,154.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.07
Rate for Payer: Qualcare PPO/HMO/WC	$865.95

WALLSTENT 22/70 11FR 100 40452

Facility

$8,813.60

Hospital Charge Code	270635130V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,322.04
Max. Negotiated Rate	$4,406.80
Rate for Payer: Aetna Commercial	$2,644.08
Rate for Payer: Aetna Medicare Advantage	$2,644.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,247.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,247.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,762.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,247.47
Rate for Payer: Cigna Commercial	$4,406.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,132.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,322.04

WALLSTENT 22/70 11FR 100 40452

Facility

$8,743.15

Hospital Charge Code	270635130
Hospital Revenue Code	278
Min. Negotiated Rate	$1,311.47
Max. Negotiated Rate	$4,371.57
Rate for Payer: Aetna Commercial	$2,622.95
Rate for Payer: Aetna Medicare Advantage	$2,622.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,748.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,229.50
Rate for Payer: Cigna Commercial	$4,371.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,115.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.47

WALLSTENT 22/70 11FR 100 40452

Facility

$8,813.60

Hospital Charge Code	270635130V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,322.04
Max. Negotiated Rate	$2,132.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,762.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,132.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,322.04

WALLSTENT 22/70 11FR 100 40452

Facility

$8,743.15

Hospital Charge Code	270635130
Hospital Revenue Code	278
Min. Negotiated Rate	$1,311.47
Max. Negotiated Rate	$2,115.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,748.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,115.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.47

WALLSTENT 9FR 16x60 75CM

Facility

$5,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270676562
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

WALLSTENT 9FR 16x60 75CM

Facility

$5,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270676562
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

Know your out-of-pocket cost for care.

All Charges